Full Time SchoolApply Now Home / Full Time School Apply Now STUDENT ENROLLMENT FORMAcademic School YearGradeLast School AttendedName of SchoolAddressTelephoneSTUDENT INFORMATIONFirst NameMiddle NameLast NameDate of BirthCity of BirthGenderStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeHome Phone NumberLanguages Spoken at Home Other Than EnglishPARENT INFORMATIONFather’s Full NameMother’s Full NameHome Address (If different than students)Home Address (If different than students)Father’s Cell Phone NumberMother’s Cell Phone NumberFather’s E-Mail AddressMother’s E-Mail AddressSiblings (Please list all siblings)NameGradeDate of BirthNameGradeDate of BirthNameGradeDate of BirthNameGradeDate of BirthPARENT OCCUPATIONFatherMotherStudent Living With:FatherMotherStepfatherStepmotherPick-Up:Please list names of anyone that will be picking up your child from preschool on a regular basisNameNameRelationshipNameRelationshipCustody:If there is a custody arrangement pertaining to your child, please make us aware of anyone that should not be allowed to pick up or acquire information about your child. *Legal documentation may be required.Please explainEmergency ContactsNamePhone NumberNamePhone NumberNamePhone NumberNamePhone NumberMedical InformationDISABILITIES: Please list any physical limitations or disabilities your child may have and what restrictions they may cause.ALLERGIES: Please list ALL allergies and medications needed. If your child has a severe food allergy please let us know immediately so we may plan snacks accordingly, as well as post signs in the classroom. We will also have to schedule a meeting with the child’s parents/caregiver to discuss emergency procedures before the child is left in our care.Child's Doctor InformationDoctor NameDoctor Phone NumberStreet AddressCityState/ProvinceZIP / Postal CodeInsurance InformationPolicyholderGroup/Member # Submit ApplicationPlease do not fill in this field.
